Aortocaval fistula

Last revised by Daniel J Bell on 12 Aug 2022

Aortocaval fistula is a rare and devastating complication of abdominal aortic aneurysm (AAA), in which the aneurysm erodes into the inferior vena cava.

Spontaneous rupture of an abdominal aortic aneurysm into the adjacent inferior vena cava occurs in <1% of all aneurysms and in ~3% of ruptured aortic aneurysms 1.

The features can be very atypical leading to a delay in diagnosis. The various factors that influence the clinical presentations are the origin, size, location and duration of the fistula:

Aortography is the modality of choice. Color Doppler ultrasound, CT and MRI may also demonstrate the same non-invasively. At times, the presence of a mural thrombus may obstruct the fistula.

Urgent surgical exploration and repair. Operative mortality of spontaneous aortocaval fistula is about 20 to 55%, figures being high predominantly due to delayed diagnosis or misdiagnosis.

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Cases and figures

  • Case 1
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  • Case 2
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